Effects of a drug minimization guide on prescribing intentions in elderly persons with polypharmacy

While frameworks exist to assist clinicians in prescribing appropriately in older patients at risk of adverse drug reactions, their impact on prescribing is uncertain.

The aim of the study was to determine the effects of a ten-step drug minimization guide on clinician prescribing intentions involving a hypothetical older patient receiving multiple drugs.

A total of 61 hospital clinicians were presented with clinical information about a hypothetical case: an 81-year-old female with 12 chronic diseases, receiving 19 different medications. On a standardized, anonymous form, each participant indicated, as a pre-test, which drugs they felt strongly inclined to discontinue or continue, and which drugs they were uncertain about. The ten-step guide was then presented and applied to the case, and participants repeated the drug selection process.

Sixty evaluable forms were analysed from 19 consultant physicians, 17 medical registrars, 7 interns/residents and 17 pharmacists. Among the entire cohort, the mean (±SD) number of drugs selected for discontinuation increased from 6.0 (±2.7) pre-test to 9.6 (±3.2) post-test (p < 0.001), with the greatest increases seen among consultant physicians (6.6 [±2.3] to 11.5 [±2.9], p < 0.001) and clinical pharmacists (5.3 [±2.6] to 8.9 [±2.2], p < 0.001). The number of drugs associated with uncertainty decreased from 3.7 (±2.9) pre-test to 1.8 (±2.3) post-test (p < 0.001) for the whole cohort, with the greatest decreases seen among consultant physicians (4.8 [±2.6] to 1.8 [±2.5], p < 0.001) and clinical pharmacists (4.5 [±3.3] to 1.9 [±2.0], p = 0.003).

This self-report study involving a hypothetical case provides evidence that a drug minimization guide may reduce inappropriate prescribing and uncertainty around drug indications.